Acute posterior fossa isodense epidural hematoma: diagnostic pitfalls on computed tomography.
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Accidents, Traffic↗
Biomedical subjects
Sheng-Hong Tseng
Publications and source records attributed to Sheng-Hong Tseng.
Chronic encapsulated intracerebral haematoma.
We report a rare chronic encapsulated intracerebral haematoma (CEICH). A 52-year-old man had two seizures. Unenhanced computed tomography scanning of the head revealed a hypodense tumour with clusters of calcification in the left temporal lobe. Magnetic resonance imaging of the brain showed a left temporal tumour with a hypointense centre and hyperintense periphery on T(1)-weighted imaging and heterogeneous hypointensity on T(2)-weighted imaging. The tumour was heterogeneously enhanced after gadolinium injection. Craniotomy was carried out and a CEICH in the left temporal lobe was completely excised. No vascular anomaly was found. The tumour was histologically confirmed to be a CEICH. The patient recovered well after the operation. In this report, we describe this rare case and discuss the characteristics of CEICH.
Brain Neoplasms↗
Pituitary abscess.
Pituitary abscess is a rare disease, but one with potentially high mortality and morbidity. We present a 46-year-old man with progressive visual disturbance and general malaise for 1 year. Endocrine studies revealed hypopituitarism, and magnetic resonance imaging revealed a pituitary lesion with suprasellar extension. We attempted to excise the lesion using a transsphenoidal approach, but pus in the pituitary fossa was found at operation, and no tumour was identified. The culture yielded coagulase-negative Staphylococcus. Antibiotics were administered for 3 weeks, and the patient made a good postoperative recovery. He required life-long hormone replacement therapy. After one and a half years of follow-up, he was well and had no evidence of focal or systemic infection. We review the literature regarding pituitary abscess and discuss the appropriate treatment and possible pathological mechanism.
Anti-Bacterial Agents↗
Interhemispheric transcorpus callosal approach in the treatment of ventricular hemorrhage with obstructive hydrocephalus.
BACKGROUND: Intraventricular hemorrhage, a frequent complication of intracerebral supratentorial hemorrhage, is associated with high rates of morbidity and mortality. Several methods have recently been developed for accelerating the clearance of intraventricular blood clots, especially during massive IVH. The present study was conducted to evaluate the interhemispheric, transcorpus callosal approach with septostomy for the management of supratentorial hemorrhage with intraventricular extension. METHODS: Eighteen patients with primary IVH or thalamic/caudate hemorrhage complicated by IVH received an operation for removal of intraventricular blood clots by the interhemispheric, transcorpus callosal approach with septostomy. All patients received a brain CT examination before and after surgery. Clinical outcomes were assessed 6 months after surgery by the GOS. RESULTS: Good clinical outcomes (GOS scores >or=4) were achieved in 45.6% of patients. In the patients with poor clinical outcome, the mean age was older (P=.001) and diabetes mellitus was more common (P=.04). Patients with thalamic hemorrhage with rupture into the third ventricle had worse clinical outcomes (P=.04). The overall mortality rate at 6 months postsurgery was 5.6%. CONCLUSION: The interhemispheric, transcorpus callosal approach with septostomy is safe and effective for direct removal of intraventricular blood clots during treatment of supratentorial hemorrhage with intraventricular extension. Further investigations involving more cases are needed to assess more fully the extent of improvement in clinical outcome attributable to this approach.
Adult↗
Acute spinal epidural hematoma after acupuncture.
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Acupuncture Therapy↗
Chimney sublaminar decompression for degenerative lumbar spinal stenosis.
OBJECT: The authors evaluated the efficacy and safety of so-called chimney sublaminar decompression, a new technique to decompress the degenerative stenotic lumbar spinal canal without stripping of the paravertebral muscles. METHODS: Eighteen patients (nine men and nine women whose mean age was 67 years) with symptoms of claudication were selected to undergo chimney sublaminar decompression. The duration of symptoms was greater than 6 months in 17 patients. Two lumbar segments were involved in seven patients, three in eight, and four in the remaining three patients. Central canal stenosis was present in 13 patients, and lateral recess stenosis in five patients. Mild spondylolisthesis was noted in seven patients. All the patients underwent chimney sublaminar decompression. After surgery, mild wound pain developed in 14 patients, moderate wound pain in two, and severe wound pain in two. The postoperative hospital stay was 4 days or fewer in 14 patients. At follow-up examination, excellent, good, and fair outcomes were achieved in 11, five, and two patients, respectively. No patient required a body brace, and no worsening of preexisting spondylolisthesis was detected. The spinal canal was increased to two- to 6.8-fold (mean 4.2-fold) the preoperative size. CONCLUSIONS: Compared with laminectomy or endoscopic surgery, the aforementioned chimney sublaminar decompression technique was an equally effective and less invasive technique in the treatment of degenerative lumbar canal stenosis.
Aged↗
Effects of irradiated tumor vaccine and infusion of granulocyte-macrophage colony-stimulating factor and interleukin-12 on established gliomas in rats.
PURPOSE: We investigated granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-12 (IL-12) infused into the injection site of irradiated tumor vaccine (TV) as therapy for gliomas. METHODS: Rats with subcutaneous RT-2 gliomas were treated with irradiated TV and/or subcutaneous infusion of GM-CSF and/or IL-12 via osmotic minipump 5 days after tumor-cell inoculation. Cytotoxic T lymphocyte (CTL) and natural killer (NK) cell activity were analyzed to investigate immune responses. Rats with intracerebral gliomas were treated with irradiated TV and infused GM-CSF/IL-12 3 days after tumor-cell inoculation. Tumor growth rates and animal survival were followed. Survivors were re-challenged with wild-type RT-2 cells subcutaneously or intracerebrally to study long-term anti-tumor immunity. RESULTS: Rats with subcutaneous gliomas treated with GM-CSF and IL-12 or TV plus GM-CSF or IL-12 did not have increased survival rate (P>0.2), but did have prolonged survival time (P<0.05); in contrast, rats treated with TV plus GM-CSF/IL-12 had increased survival rate (P<0.05) and prolonged survival time (P<0.05) compared with controls. These treatment strategies showed enhanced CTL and NK cell activities. Rats with intra-cerebral gliomas treated with TV plus GM-CSF/IL-12 did not have increased survival rate (P=0.11), but did have prolonged survival time (P<0.0001). Survivors in each group were re-challenged with wild-type RT-2 cells, and all had long-term survival. CONCLUSIONS: Irradiated TV plus continuous localized infusion of GM-CSF/IL-12 may induce a tumor-specific anti-tumor immune response on established subcutaneous or intra-cerebral gliomas, and such a treatment strategy deserves consideration as adjuvant treatment for glioma.
Animals↗
Induction of T-cell apoptosis in rats by genetically engineered glioma cells expressing granulocyte-macrophage colony-stimulating factor and B7.1.
PURPOSE: To evaluate antitumor effects on intracerebral gliomas of genetically engineered tumor vaccines expressing granulocyte-macrophage colony-timulating factor (GM-CSF), B7.1, or both (combination). EXPERIMENTAL DESIGN: A rat glioma cell line, RT-2, was engineered with a retroviral vector to express GM-CSF, B7.1, or combination. Tumorigenicity of engineered cells and therapeutic effects of s.c. given irradiated or live tumor vaccines on parental intracerebral gliomas were studied. Immune cell infiltration induced at vaccine and tumor sites was examined by histologic and immunohistochemical staining. Apoptosis of T cells from vaccine sites was analyzed with fluorescence-activated cell sorting. RESULTS: Engineered RT-2 cells exhibited reduced s.c. tumorigenicity in rats with reduced tumor growth and prolonged animal survival time compared with control rats. Rats with intracerebral gliomas s.c. treated with irradiated or live GM-CSF-expressing vaccines had 60% and 100% survival rates, respectively, significantly better than the control groups (P < 0.05). In contrast, rats treated with vaccines expressing B7.1 or the combination had no or mild therapeutic effects. Studies revealed less T-cell infiltration at both vaccine and tumor sites in rats treated with vaccines expressing B7.1 or the combination than in rats treated with a vaccine expressing GM-CSF. Cell sorting analyses revealed higher proportions of apoptotic T cells at vaccine sites of rats treated with the combination than those treated with vaccine expressing GM-CSF. CONCLUSIONS: Combination of GM-CSF- and B7.1-expressing tumor vaccines exerted no synergistic, or even worse, therapeutic effects on gliomas compared with single GM-CSF-secreting tumor vaccine. The worse therapeutic effects of the GM-B7.1-expressing tumor vaccine than the GM-CSF-expressing tumor vaccine were related to the reduced T-cell amount and increased T-cell apoptosis in the former.
Animals↗
Cervical dumbbell meningioma and thoracic dumbbell schwannoma in a patient with neurofibromatosis.
The occurrence of both dumbbell meningioma and dumbbell schwannoma in one patient has not been reported in the literature. We present a 16-year-old female patient, who had progressive bilateral hearing impairment for 5 years and a progressively enlarged, non-tender neck mass for 1.5 years. Mild motor weakness over her right upper limb was noted 1 week before admission. No café-au-lait spot was noted. Magnetic resonance imaging (MRI) revealed bilateral cerebellopontine angle tumors, a C1-2 dumbbell tumor, and a T5-6 dumbbell tumor. Neurofibromatosis type 2 was diagnosed. The cervical spine and thoracic spine tumors were removed via one-staged combined posterior (laminectomy) and antero-lateral (transforaminal or thoracoscopic) approaches during two operations performed 1 month apart. The pathology revealed meningioma and schwannoma, respectively. The patient had good recovery after these two operations and her motor function improved. Six months after the second surgery, radiosurgery was performed for the bilateral acoustic tumors, because of enlarged tumor size on follow-up MRI. To the best of our knowledge, this is the first case reported in the literature of a patient, having both dumbbell meningioma and dumbbell schwannoma. A literature review of the dumbbell tumors was done, and their treatment strategies were discussed.
Adolescent↗
Laparoscopic appendectomy in pregnancy.
BACKGROUND: Laparoscopic appendectomy (LA) is a safe, effective, and beneficial procedure for the treatment of acute appendicitis. However, limited data are available regarding the safety and feasibility of LA during pregnancy. METHODS: Between January 2001 and August 2004, 1235 patients with clinically suspected appendicitis underwent laparoscopic surgery at our hospital. Eleven patients (0.9%) were pregnant women (mean age, 25 years; age range, 19-37 years; range of gestational age, 4-30 weeks). Clinical data collected retrospectively included demographic information; preoperative, procedural, and postoperative information; and outcome of the pregnancy. RESULTS: All 11 pregnant women underwent laparoscopic surgery without need of conversion. Ten patients underwent LA and were found to have acute appendicitis on histologic analysis. One patient had torsion of the right fallopian tube and a healthy-looking appendix; she underwent detorsion of the fallopian tube and incidental appendectomy. Mean operative time was 50.5 minutes (range, 20-135 minutes). Length of postoperative hospital stay averaged 4.2 days (range, 1-11 days). One patient had a surgical wound infection, which was managed conservatively. Mean follow-up period was 14 months (range, 2-46 months). Seven pregnant women delivered healthy term infants, 2 had planned abortions, and 1 experienced fetal loss due to uterine infection and premature contractions 1 month after LA. Another patient had normal results at prenatal examination. CONCLUSION: Our data support the accumulating evidence that LA is a safe and feasible procedure for the treatment of acute appendicitis in all trimesters of pregnancy. Close maternal and fetal monitoring is essential during and after the operation.
Adult↗
Sylvian fissure dermoid cyst with intratumoral hemorrhage: case report.
It is rare for a dermoid cyst to develop intratumoral hemorrhage. A 61-year-old woman had a sudden-onset left hemiparesis and slow response to verbal requests for one week when unenhanced computed tomography scanning revealed a mixed iso- and hypo-dense heterogeneous lesion in the right fronto-temporal area. T1-weighted magnetic resonance imaging (MRI) of the brain showed a mixed hyper- and hypo-intense tumor in the right fronto-temporal area. The tumor became hyperintense on T2-weighted MRI and was faintly enhanced at tumor periphery on T1-weighted MRI. The tumor was excised and pathological examination revealed a dermoid cyst with intratumoral hemorrhage. The post-operative course was complicated by hemorrhage in the tumor bed, which was evacuated immediately. The patient improved and could walk without support two weeks after the second operation. After 1 year of follow-up, she was well and without neurological deficits. To the best of our knowledge after a literature review, only two previous cases of dermoid cyst have featured intratumoral hemorrhage.
Brain Stem Neoplasms↗
Resveratrol suppresses the angiogenesis and tumor growth of gliomas in rats.
PURPOSE: We wanted to investigate the antitumor effects and effect on angiogenesis of resveratrol in rat RT-2 gliomas. EXPERIMENTAL DESIGN: RT-2 glioma cells were treated with resveratrol, and then cytotoxicity was assayed, apoptosis was measured by flow-activated cell sorter flow cytometry, and expression of vascular endothelial growth factor was measured by reverse transcription-PCR. Tumor size, animal survival time, and survival rate were followed in resveratrol-treated rats with s.c. or intracerebral gliomas. Furthermore, in vitro proliferation was assayed to explore the effect of resveratrol on the proliferation of ECV304 human umbilical vein endothelial cells. Expression of CD31 in resveratrol-treated gliomas was followed immunohistochemically to study the effect of resveratrol on the glioma-induced angiogenesis. RESULTS: Resveratrol was demonstrated to exert cytotoxic effects and induce glioma cell apoptosis in a concentration- and time-dependent manner (P < 0.05). Resveratrol (40 mg/kg/day) exerted significant antitumor effects on s.c. tumors, including slower tumor growth rate, longer animal survival time, and higher animal survival rate (P < 0.05). In contrast, resveratrol affected intracerebral tumors at only an increased dose (100 mg/kg/day), prolonging animal survival (P < 0.05) without affecting survival rate. The expression of vascular endothelial growth factor in the glioma cells and the proliferation of ECV304 cells were inhibited by resveratrol in a concentration-dependent manner. Immunohistochemical analyses showed that the s.c. gliomas from resveratrol-treated rats had fewer microvessel densities than did control rats (P < 0.01). CONCLUSIONS: Resveratrol caused significant glioma cell cytotoxicity and apoptosis, exerted antitumor effects on the s.c. and intracerebral gliomas, and inhibited angiogenesis in s.c. gliomas. Thus, resveratrol might be considered a possible treatment strategy for gliomas.
Angiogenesis Inhibitors↗
Activation of c-Jun N-terminal kinase 1 and caspase 3 in the tamoxifen-induced apoptosis of rat glioma cells.
PURPOSE: The mechanisms of the antitumor effects of tamoxifen upon gliomas are still unclear. In this study, we investigated the role of c-Jun N-terminal kinase-1 (JNK1) and caspase 3 in the tamoxifen-induced apoptosis of rat glioma cells. METHODS: Glioma cells were treated with tamoxifen, followed by a cytotoxicity assay to study its effects on the cells, and then a flow-activated cell sorter (FACS) analysis was performed to analyze the cellular apoptosis of the glioma cells. The expression of JNK1 and phospho-specific JNK1 in glioma cells treated with tamoxifen was investigated by Western blot analysis. The activity of caspase 3 in glioma cells was analyzed by caspase activity assay. RESULTS: Tamoxifen was demonstrated to exert cytotoxic effects upon and induced apoptosis of the glioma cells in a concentration- and time-dependent manner (P<0.05). Western blot analysis demonstrated that tamoxifen increased the expression of phospho-specific JNK1 in glioma cells, and an increasing concentration of tamoxifen induced an increasing expression of phospho-specific JNK1. Four-hour 50-microM tamoxifen treatment increased the expression of phospho-specific JNK1 to 3.2 times that of the control level in glioma cells. Tamoxifen also increased the activity of caspase 3 in glioma cells. Pretreatment of glioma cells with the antisense oligonucleotide (OGN) of JNK1 immediately prior to tamoxifen treatment suppressed the expression of phospho-specific JNK1 and the activity of caspase 3. The apoptosis fraction of glioma cells induced by 4-h treatment with 50 microM tamoxifen was decreased from 51% to 28% by pretreatment with the antisense OGN of JNK1 (P<0.003), and to 20% by pretreatment with caspase 3 inhibitor (DEVD-CHO) (P<0.0008). CONCLUSIONS: The results suggest that the tamoxifen-induced apoptosis of rat glioma cells is related to the activation of the JNK1/caspase 3 signaling pathway; however, the confirmation of the occurrence of such activation in vivo needs further investigation.
Animals↗
Fetal bovine serum suppresses apoptosis in the small intestine after total ischemia and reperfusion in mice.
BACKGROUND/PURPOSE: Total ischemia/reperfusion (I/R) of the small intestine induces cellular apoptosis. In this study, the authors investigated the effects of fetal bovine serum (FBS) on apoptosis and related proapoptotic and antiapoptotic factors in the I/R-injured small intestine of mice. METHODS: The mice underwent total I/R of the small intestine and were treated with oral gavages of normal saline or FBS for 3 days, concluding with total ischemia of the small intestine. Samples of the I/R-injured small intestine, representing various predefined time-points post-I/R (immediately before and after 1 hour of total ischemia and at 1, 6, and 24 hours after initiation of reperfusion), were subjected to terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining to study the cellular apoptosis, and Western blot analysis to measure expression of p53, bcl-2 and bax, with caspase-activity assay used to determine the activity of caspase 3. RESULTS: For the saline-treated mice, increased cellular apoptosis, suppressed expression of p53 and bcl-2 (with decreased bcl-2 to bax ratio) and increased caspase-3 activity were found for the I/R-injured small intestine. By contrast, FBS treatment suppressed cellular apoptosis, producing up-regulation of p53 and bcl-2 (with increased bcl-2 to bax ratio to 5.4-fold of the saline-treated group) and inhibiting the activity of caspase 3 (P <.05). CONCLUSIONS: The results of our study suggest that I/R-induced apoptosis of the mouse small intestine may be related to p53 and bcl-2 suppression (with decreased bcl-2 to bax ratio) and activation of caspase 3 and that such apoptosis seems to be suppressed by FBS treatment.
Animals↗
Resveratrol-induced cellular apoptosis and cell cycle arrest in neuroblastoma cells and antitumor effects on neuroblastoma in mice.
BACKGROUND: The prognosis of neuroblastoma patients remains unsatisfactory. Therefore, developing an effective treatment strategy is important. Resveratrol, a natural polyphenol, possesses chemopreventive and antitumor effects. We investigated the effects of resveratrol on the proliferation, apoptosis, and cell cycle alteration of neuroblastoma cells and determined its effects on neuroblastoma tumors in mice. METHODS: Cytotoxic effects, cellular apoptosis, and alterations in the cell cycle were determined in neuro-2a neuroblastoma cells exposed for varying lengths of time to a series of resveratrol concentrations. Expression of associated cell cycle regulatory proteins, cyclin E and p21, was detected by Western blot analysis, and the antitumor effects of resveratrol were investigated by treating subcutaneous neuroblastoma tumors with intraperitoneal injections of 40 mg/kg resveratrol daily for 28 days. RESULTS: Resveratrol exerted cytotoxic effects on neuroblastoma cells. After resveratrol treatment, the apoptosis rate of the neuroblastoma cells significantly increased, a significant accumulation of cells occurred at the S phase of the cell cycle, p21 was downregulated, and cyclin E was upregulated. In addition, resveratrol treatment suppressed the growth rate of subcutaneous neuroblastomas, resulting in 70% long-term survival. CONCLUSION: Resveratrol caused significant cytotoxicity and increased apoptosis and S-phase accumulation of neuroblastoma cells. S-phase accumulation was related to the down-regulation of p21 and up-regulation of cyclin E. In addition, resveratrol exerted antitumor effects on neuroblastomas in mice. Thus, resveratrol shows promise for the treatment of neuroblastoma.
Animals↗
Intra-retroperitoneal duplication cyst.
Duplication cyst occupying the retro- and intra-peritoneal space is a rare condition. We describe a case of duplication cyst in a 13-year-old girl who presented with abdominal pain, vomiting, and a lower abdominal mass. Plain abdominal X-ray films revealed local ileus over the lower abdomen. Ultrasonography revealed 2 double-layered cystic masses over the lower abdomen with a suspicious communicating tract. Mild hydropelvis of the right kidney was also noted. Abdominal computed tomography revealed 2 cystic lesions. One was located at the pelvic cavity just above the urinary bladder and the other was in the left retroperitoneal space. Laparotomy revealed a dumbbell-shaped intra-retroperitoneal duplication cyst with a small communicating tract. The cyst was excised without disturbing bowel continuity and the vascular supply. The patient was doing well at 1-year follow-up.
Adolescent↗
Radiation-induced temporary alopecia after embolization of cerebral arteriovenous malformations.
Alopecia after endovascular embolization of cerebral arteriovenous malformations (AVMs) is uncommon. In this report, we present a 33-year-old man who developed temporary alopecia after staged embolization of a cerebral AVM. Four days after the last procedure, this patient had hair loss over his right temporoparietal and occipial areas. No scalp erythema or other sign of dermatitis was noted. The hair regrew 2 months later. The alopecia was considered to be related to repeated exposure to radiation during embolization. The experience in this case and review of the literature suggest that interventional neuroradiological procedures may cause substantial radiation exposure to the patient. Therefore, radiation use should be limited to the least amount necessary to complete the endovascular procedure to prevent radiation-induced biological changes and morbidity. Patients should be well informed of adverse effects such as alopecia.
Adult↗
Primary volvulus of the ileum in a preterm infant.
Primary volvulus of the small intestine is rare in neonates. We report a case of primary volvulus of the ileum in a preterm newborn. Vomiting and abdominal distension began 10 hours after birth, followed by hypovolemia, hyponatremia, and acidosis. Plain abdominal radiograph revealed a pattern of diffuse ileus and very dilated loops at the right upper quadrant of the abdomen. Three days later, another plain film showed increased fluid accumulation and decreased air in these dilated loops. Emergency laparotomy revealed primary volvulus of the distal ileum with gangrenous change. Resection of the necrotic ileum with an end-to-end ileoileostomy was performed and the patient recovered fully. In a newborn with ileus and rapidly deteriorating hemodynamics, early surgical intervention is essential to achieve good prognosis.
Female↗